Healthcare Provider Details

I. General information

NPI: 1811046238
Provider Name (Legal Business Name): RACHEL CHIENYENWA EGBUJOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6484 FORT CAROLINE RD
JACKSONVILLE FL
32277-2042
US

IV. Provider business mailing address

6484 FORT CAROLINE RD
JACKSONVILLE FL
32277-2042
US

V. Phone/Fax

Practice location:
  • Phone: 904-745-3618
  • Fax: 904-722-4271
Mailing address:
  • Phone: 904-744-7300
  • Fax: 904-722-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTRN10233
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME104984
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: